CMS Price Transparency Data

Ultrasound, pelvis

Facility: Stonesprings Hospital Center

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $422
Cash Discount Price: $1,275
vs. Medicare Baseline: 3.95x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Stonesprings Hospital Center is $422. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,275. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 3.95x the Medicare baseline. Located in 24440 Stone Springs Boulevard, Dulles, VA.

Cash / Self-Pay

$1,275

Average discount available for prompt cash payment at this facility.

Insurance Median

$422

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$106.81

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $106.81 (100%)

Cash / Self-Pay: $1,275 (1194%)

Insurance Median: $422 (395%)

Cash: $1,275 (1194% of Medicare)

Ins. Median: $422 (395% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $106.81 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 395% of the Medicare baseline (a markup of 295%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Blue Cross Blue Shield	$125 - $452	117%
Lifeworks	$242	227%
United	$245 - $574	229%
Cigna	$422 - $442	395%
Carefirst	$430	403%
Greenvbrier Sporting Club	$765	716%
Virginia Health Network	$905	847%
Corvel	$918	859%
Three Rivers Provider Network	$1,084	1015%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $1,275.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 76856.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Stonesprings Hospital Center is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 76856.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.